Birth-Rate Policies Whip-Saw Women in Peru

(WOMENSENEWS)–The reproductive lives of Peruvian women are like the shuttlecock in a game of political badminton.

On one side of the net is the previous Fujimori government in Peru, which strove to lower the birth rate by encouraging birth control. In the mid-1990s, the regime of President Alberto Fujimori went so far as to adopt a program of forced sterilization, using incentives such as free food and threats of fines to coerce more than 200,000 Peruvian women into “opting” for sterilization as their method of birth control. This was hardly necessary since between 1970 and 2000 the use of voluntary family planning had led the total fertility rate for Peru to fall from 6.0 children per woman to 2.6 children per woman.

Now, the current Peruvian government of President Alejandro Toledo has taken the other side of the net and is undertaking coercive programs to increase the birth rate. It is not providing sterilization and is not providing birth control either. Local women’s advocates report that clinics that are supposed to serve the poor are not carrying birth-control pills and other contraceptives.

Abortion, except to save the life of a mother, is illegal. The pill and the intrauterine device are considered by the Toledo government to cause abortion and not to be birth control, since they may operate by not only preventing ovulation and fertilization, but by preventing implantation of the fertilized egg. Pills and IUD’s are disappearing from the market. So are condoms.

The Peru health ministry last year denounced condoms that contained the spermicide nonoxynol-9. This spermicide was found by the World Health Organization to potentially increase a woman’s chances of contracting HIV, since the spermicide aggravated the lining of the vagina, making it easier for HIV to penetrate the vaginal walls. The WHO, however, reiterated that using these types of condoms was better than no condom use, but the Peruvian government failed to mention this or to recommend other types of condoms other than those containing spermicide, thus leaving the impression that all condoms were dangerous.

This, however, is just the tip of the compulsory motherhood iceberg.

Pregnancy Register Established in May

Last May, the government began requiring women to register their pregnancies “from the moment of conception.” It also proposed a law that would, among other things, confer legal personhood on the fertilized egg: “A person’s life begins at conception, when an egg is fertilized by a sperm.”

Finally, the proposed law calls the “family,” not the “individual,” the basic health unit. The implications of this law are unclear, but could include that all the medical conditions, decisions and treatments of one spouse are shared with the other. This could lead to further negative health consequences for women. While bringing in a woman’s husband or partner can be helpful in assuring compliance with the birth control method that the woman chooses, it is not helpful when a husband is given veto power over his wife’s method of contraception.

In addition, a woman is at a special risk for contracting sexually transmitted diseases that her husband may bring home. Throughout Latin America, married women are the fastest growing group contracting HIV. A woman needs to get confidential medical advice in order to reduce her risks. A husband also needs confidential medical advice to get treatment and to prevent, if possible, passing on any infection to his wife. While the sexual behavior of husbands and wives clearly affects the other, it is frequently best that each party be dealt with separately and privately, and not together.

Many of these regulations and laws are not only unscientific–no one knows, for instance, when a conception occurs—but also could create a public-health disaster. Although the laws are advertised as being designed to improve access to health care, women’s fear that they will be punished for noncompliance with the new laws will actually deter them from seeking medical attention. Seekers of post-abortion care will be especially fearful. The result can only be more suffering and health damage to women.

Registering pregnancies from the moment of conception was decreed in Communist Romania under the dictatorship of Nicolai Ceausescu, with devastating consequences. Birth control was banned and women were forced to undergo a monthly gynecological examination to detect pregnancies, which were then duly registered. Birth quotas were established and couples were penalized if they did not have children after two years of marriage. The birth rate in Romania quickly doubled. Women began resorting to illegal abortion, and the birthrate soon fell to near its previous level. Unwanted children were left in state orphanages where many perished under appalling conditions. Maternal mortality doubled and gynecological injuries to women who had unsafe abortions also grew, resulting in the involuntary sterilization of 10 percent of Romanian women.

More than a million women in Peru get pregnant each year; 600,000 give birth and about 350,000 undergo illegal abortions, with the balance miscarrying. Except when it is necessary to save the life or health of the mother, abortion is illegal in Peru. Despite these exceptions, abortion is largely unavailable, and women frequently resort to illegal abortion. There is no indication that Peruvian women–especially now that they have less access to contraception–will make less rather than more use of abortion.

Better Ways to Reduce Maternal Mortality

The Toledo government is portraying the goal of the regulation and proposed laws as that of reducing maternal mortality. Since abortion is already mostly illegal, however, the real purpose seems to be scaring women away from illegal abortions.

Perhaps the embryo registry (or more accurately zygote registry) will be used to compel women to seek prenatal care and to keep their appointments. The government is promising to improve prenatal care. If Peru had a functioning health care system, this might be laudable. But it doesn’t. Given that its current registry system can’t keep track of births and deaths accurately, it is hard to imagine how it will do a better job keeping track of embryos and prenatal appointments.

If the goal is reducing maternal mortality, Peru’s resources would be much better spent encouraging wanted pregnancies, properly spaced pregnancies and competent delivery services. Instead, Peruvian women are being sentenced to a case of Fujimori redux, where they are considered unable to make their own childbearing decisions.

Another effect of the Toledo laws will be to discourage women from getting post-abortion care. About 1 in 7 women who have illegal abortions end up in the hospital. Even though current law requires health professionals to report these cases to the authorities, one can imagine increased pressure because of the new laws to report and punish women who have abortions. Similarly with women who have a miscarriage.

The sad irony of the Toledo proposals, which will inevitably result in more illegal abortions and less treatment of sexually transmitted infections, is that they may end up involuntarily sterilizing more women than the Fujimori administration ever did.

Alexander C. Sanger is the grandson of Margaret Sanger, who founded the birth-control movement over 80 years ago. He is chair of the International Planned Parenthood Council of the International Planned Parenthood Federation, Western Hemisphere Region, serves as a Goodwill Ambassador for the United Nations Population Fund and is writing a book on the future of the reproductive-rights movement.